American Journal of Nephrology最新文献

{"title":"A Phase III Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Evaluating Desidustat's Efficacy and Safety in Non-Dialysis Chronic Kidney Disease Patients with Anemia.","authors":"Jie Ma, Xiangdong Yang, Xiaoyan Xiao, Changyou Sun, Qinghong Zhang, Caili Wang, Yan Xu, Jianrong Zhao, Aicheng Yang, Hong Cheng, Menghua Chen, Wenli Chen, Zhihua Zheng, Yongjun Shi, Zhanzheng Zhao, Zhenhua Yang, Lin Yang, Li Yao, Xiaoshi Zhong, Yilan Deng, Zuying Xiong, Xiaoping Yang, Chunjiang Zhang, Weiji Xie, Aiping Yin, Hua Zhou, Weihong Bi, Wenbin Li, Junxia Wang, Suhua Li, Yuanyuan Yin, Xuemei Li","doi":"10.1159/000551113","DOIUrl":"10.1159/000551113","url":null,"abstract":"<p><strong>Introduction: </strong>This phase III trial assessed desidustat's efficacy and safety compared with placebo for the treatment of anemia in non-dialysis-dependent chronic kidney disease (NDD-CKD).</p><p><strong>Methods: </strong>A multicenter, randomized, double-blind trial enrolled 152 NDD-CKD patients with anemia (101 desidustat, 51 placebo).</p><p><strong>Primary endpoint: </strong>hemoglobin (Hb) change from baseline to weeks 7-9. Secondary endpoints included Hb response rate (≥100 g/L), time to target Hb, and target Hb maintenance (100-120 g/L). Safety evaluated treatment-emergent adverse events (TEAEs). Exploratory endpoints analyzed Hb dynamics (weeks 21-25) and serum hepcidin levels (baseline-week 53).</p><p><strong>Results: </strong>After 9 weeks of treatment, desidustat increased Hb level from 89.18 g/L to 105.66 g/L, whereas placebo decreased from 89.41 g/L to 88.51 g/L, with a mean difference of 17.52 g/L (95% confidence interval [CI]: 14.35-20.68) in the full analysis set. And in the per protocol set, desidustat increased Hb level from 88.86 g/L to 105.62 g/L, and placebo declined from 89.37 g/L to 87.57 g/L, with a mean difference of 18.39 g/L (95% CI: 15.39-21.39). Hb response rates were 85.15% vs. 23.53% (p < 0.001). Median time to target Hb was 30 days with desidustat vs. 0 days with placebo (p < 0.001). By week 9, desidustat maintained Hb within target range 51.68% of the time vs. 10.24% for placebo (p < 0.001). TEAE incidence was comparable between groups. During weeks 21-25, Hb rose further (desidustat: +21.26 g/L; placebo: +26.63 g/L). Serum hepcidin decreased sharply in desidustat by week 9 (-67.43 ng/mL vs. -6.38 ng/mL; placebo), though placebo showed delayed reduction by week 25 - levels equalized by week 53.</p><p><strong>Conclusion: </strong>Desidustat significantly improved Hb levels and accelerated anemia correction in NDD-CKD patients versus placebo, with comparable safety.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast Media in Hospitalized Patients with Acute Kidney Injury: Renal and Clinical Outcomes.","authors":"Alon Bnaya, Razan Said, Linda Shavit","doi":"10.1159/000550929","DOIUrl":"10.1159/000550929","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is a common complication among hospitalized patients and is associated with substantial morbidity and mortality. Intravenous contrast media are frequently used in diagnostic imaging, but data on its safety in patients with established AKI remain limited. This study prospectively assessed renal and clinical outcomes following intravenous contrast administration in hospitalized patients with AKI.</p><p><strong>Methods: </strong>In this prospective observational study, we included hospitalized adults diagnosed with AKI who underwent CT imaging with or without intravenous contrast between January 2023 and March 2024. The primary outcome was renal recovery within 7 days, defined as return of serum creatinine to baseline. Secondary outcomes included renal improvement within 72 h, dialysis requirement after CT, length of stay, and in-hospital mortality. Analyses were performed using inverse probability weighting (IPW), with propensity score matching (PSM) as a secondary robustness analysis.</p><p><strong>Results: </strong>A total of 481 patients were analyzed; 282 received contrast and 188 did not. After IPW adjustment, renal recovery within 7 days occurred in 61.7% of the contrast group vs. 47.3% of the non-contrast group (OR: 1.7, 95% CI: 1.0-2.97, p = 0.05). Secondary outcomes were similar between groups. Results were consistent in a secondary PSM analysis. In the overall cohort, higher AKI stage and acute tubular injury were independently associated with lower recovery odds.</p><p><strong>Conclusion: </strong>In hospitalized patients with AKI, intravenous contrast administration was not associated with worse renal or clinical outcomes, suggesting that contrast-enhanced CT may be acceptable in selected clinical settings.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolvaptan for Autosomal Dominant Polycystic Kidney Disease: Real-World Insights from a Propensity Score Weighted Retrospective Cohort Study.","authors":"William R Marshall, Rajkumar Chinnadurai, Sharmilee Rengarajan, Áine De Bhailís, Julie Gorton, Philip A Kalra, Grahame Wood","doi":"10.1159/000551244","DOIUrl":"10.1159/000551244","url":null,"abstract":"<p><strong>Introduction: </strong>Tolvaptan slows disease progression of autosomal dominant polycystic kidney disease (ADPKD) in clinical trials, but real-world effectiveness remains uncertain. We evaluated the association between tolvaptan use and kidney function decline in a large tertiary-centre cohort.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated adults with ADPKD attending a specialist polycystic kidney disease clinic. Patients with <1 year of follow-up or <3 estimated glomerular filtration (eGFR) measurements were excluded. eGFR slopes were estimated using piecewise linear mixed-effects models separating acute (<60 days) and chronic (≥60 days) phases, with the chronic slope defined as the primary outcome. Multivariable mixed-effects models and propensity score overlap weighting were used to adjust for baseline differences in covariates. Complete case analysis was performed as the primary analysis; multiple imputation was used as a sensitivity analysis. Patients receiving <6 months of tolvaptan were excluded from the primary slope analyses but retained for intention-to-treat comparisons.</p><p><strong>Results: </strong>Of 327 patients, 119 initiated tolvaptan and 208 did not; mean duration of study follow-up was 61.4 months. Tolvaptan-treated patients had a lower baseline eGFR and trended towards a faster pre-study eGFR decline. After full adjustment, tolvaptan was associated with a modest slowing in the chronic eGFR slope of +0.45 mL/min/1.73 m2/year; however, confidence intervals (CIs) were wide (95% CI: -0.37 to +1.18) and therefore compatible with clinically meaningful benefit or no effect. Findings were directionally consistent across complete-case, overlap-weighted, and multiple-imputation analyses with similarly imprecise CIs. A total of 61 (52.1%) patients discontinued therapy within 12 months of initiation, primarily due to aquaretic side effects. In subgroup analyses, tolvaptan patients treated for ≥1 year and tolvaptan responders treated for ≥2 years showed greater magnitudes of benefit with chronic slopes of +0.58 and +0.78 mL/min/1.73 m2/year, respectively, when compared to untreated matched cohorts.</p><p><strong>Conclusion: </strong>Tolvaptan was not associated with a statistically significant slowing of kidney function decline. Point estimates suggest a modest potential benefit which is attenuated when compared to controlled trials. Treatment discontinuation substantially limited treatment exposure. Further real-world evidence is required to clarify tolvaptan's true effectiveness outside controlled trial settings.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147315995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canagliflozin Reduces Proteinuria and Mitochondrial Fission in Membranous Nephropathy Rats via CAV1/PKA/DRP1 Inhibition.","authors":"Xin Lv, Liling Cui, Hongyan Liu, Hongkun Wei, Jia Xu, Dandan He, Caiyun Yan, Wen Shao","doi":"10.1159/000550928","DOIUrl":"10.1159/000550928","url":null,"abstract":"<p><strong>Introduction: </strong>Membranous nephropathy (MN) is a common glomerular disease characterized by immune complex deposition, glomerular filtration barrier impairment, and severe proteinuria, which may potentially progress to end-stage kidney disease. Podocyte injury and mitochondrial dysfunction are key pathological features of MN. Caveolin-1 (CAV1) is upregulated in MN, and we hypothesized canagliflozin alleviates MN via inhibiting the CAV1/PKA/DRP1 pathway.</p><p><strong>Methods: </strong>The publicly available GEO dataset GSE115857 was analyzed for CAV1 expression. MN rats induced by cationic bovine serum albumin were treated with canagliflozin (10 mg/kg/day). MPC-5 podocytes were stimulated with C5a and treated with canagliflozin or CAV1 overexpression. Renal function, histopathology, apoptosis, mitochondrial membrane potential (MMP), and pathway-related proteins were assessed.</p><p><strong>Results: </strong>The results of this study show that CAV1 was upregulated in MN. Canagliflozin reduced proteinuria, increased serum albumin, and improved renal histology in MN rats. It restored podocyte markers (nephrin and podocin), inhibited CAV1/PKA/DRP1 signaling, preserved MMP, suppressed proapoptotic proteins (Bax and caspase-3), and upregulated Bcl-2. CAV1 overexpression reversed canagliflozin's protective effects.</p><p><strong>Conclusion: </strong>Our study demonstrates that canagliflozin alleviates MN by inhibiting the CAV1/PKA/DRP1 pathway, suppressing mitochondrial fission and podocyte apoptosis, and supporting its potential clinical application in MN.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-15"},"PeriodicalIF":3.2,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146256925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Deposits, Complement Activation, and <italic>APOL1</italic> Risk Variants in Focal Segmental Glomerulosclerosis.","authors":"Yasar Caliskan, Virginie Royal, Stéphan Troyanov, Arnaud Bonnefoy, Clémence Merlen, Mark Schnitzler, John C Edwards, Louis-Philippe Laurin, Krista L Lentine","doi":"10.1159/000551083","DOIUrl":"10.1159/000551083","url":null,"abstract":"<p><strong>Introduction: </strong>The role of immune deposits and complement activation in APOL1-mediated focal segmental glomerulosclerosis (FSGS) remains unclear. Using the CureGN cohort, we examined the associations between APOL1 renal risk variants (RRVs), glomerular immune deposits, and urinary complement activation.</p><p><strong>Methods: </strong>We analyzed glomerular IgG, IgM, and C3 deposition, kidney biopsy findings, urinary membrane attack complex (sC5b9) levels, and clinical data in FSGS patients, regardless of race. Study participants were categorized as high-risk (two RRVs) or low-risk (zero to one RRV).</p><p><strong>Results: </strong>Of 175 participants, 148 (84%) had genetic testing, among whom 31 were high-risk and 117 were low-risk participants. High-risk participants had a higher prevalence of collapsing FSGS (45% vs. 11%, p < 0.001) and mesangial IgG deposition (intensity >0) (32% vs. 3%, p < 0.001). Incident participants enrolled within 6 months of biopsy showed a trend toward higher urinary sC5b9-to-protein ratio in high-risk participants (0.15 [0.08-0.31] vs. 0.03 [0-0.20] μg/g, p = 0.09). IgG staining correlated with urinary sC5b9 levels (r = 0.34, p = 0.008), suggesting a link between IgG deposition and urinary membrane attack complex excretion.</p><p><strong>Conclusions: </strong>APOL1 high-risk FSGS is associated with mesangial IgG deposition and increased urinary membrane attack complex levels, implicating immune-mediated mechanisms in FSGS pathogenesis.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-7"},"PeriodicalIF":3.8,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods Article for a Study Protocol: Study Design and Baseline Characteristics of the Treatment of Cardiovascular Disease with Low Dose Rivaroxaban in Advanced Chronic Kidney Disease (TRACK) Trial.","authors":"Sunil V Badve, Maha Al Ammari, Craig S Anderson, Laurent Billot, Severine Bompoint, David Collister, An S De Vriese, John W Eikelboom, Adrien Flahault, Amit X Garg, Jeffrey T Ha, Hiddo J L Heerspink, Meg J Jardine, Shilpanjali Jesudason, Vivekanand Jha, Min Jun, Jenny Landrigan, Adrian Liew, Enmoore Lin, Jicheng Lv, Patrick B Mark, Jan Menne, Helen Monaghan, Lily Mushahar, Anushka Patel, Helen Pilmore, Vlado Perkovic, Raja Ramachandran, Patrick Rossignol, Ahmed Shaman, Habib Skhiri, Michael Walsh, David C Wheeler, Muh Geot Wong, Li Zuo, Martin Gallagher","doi":"10.1159/000550796","DOIUrl":"10.1159/000550796","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with advanced stages of chronic kidney disease (CKD) and dialysis-dependent kidney failure are at a greater risk of cardiovascular events and mortality than those with early stages of CKD. There are no completed definitive randomized trials on the safety and efficacy of anticoagulant therapy in this patient population.</p><p><strong>Methods: </strong>Treatment of cardiovascular disease with low-dose Rivaroxaban in Advanced Chronic Kidney disease (TRACK) is a multicenter, randomized, placebo-controlled trial (NCT03969953), designed to enroll 1,886 adult participants with CKD stage 4 or 5 (estimated glomerular filtration rate ≤29 mL/min/1.73 m2) or dialysis-dependent kidney failure and high cardiovascular risk (defined as at least one of the following risk factors; coronary artery disease, nonhemorrhagic non-lacunar stroke, peripheral artery disease [PAD], diabetes mellitus, or age ≥65 years). Participants are randomized to rivaroxaban 2.5 mg twice daily or matching placebo. The primary efficacy outcome is a composite of cardiovascular death, myocardial infarction, stroke, or PAD event. The primary safety outcome is major bleeding, defined as a composite of fatal bleeding, bleeding leading to hospitalization, or symptomatic bleeding in a critical area or organ. From January 2021 to July 2025, 1,458 eligible participants (mean age 63.2 years, 700 [48%] age ≥65 years, 432 [29.6%] women, 715 [49%] dialysis-dependent kidney failure and 743 [51%] CKD stage 4 or 5, 1,125 [77.2%] diabetes mellitus, 674 [46.2%] treated with aspirin at baseline) underwent randomization.</p><p><strong>Conclusion: </strong>TRACK will evaluate the effect of low dose rivaroxaban on major adverse cardiovascular events in participants with CKD stages 4 and 5 and dialysis-dependent kidney failure, and elevated cardiovascular risk.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise Training and Progression of Chronic Kidney Disease: The GFR-Exercise (GFR-Ex) Randomized Controlled Feasibility Study.","authors":"Mark David Davies, Juliet Briggs, Abdulfattah Alejmi, Jamie Hugo Macdonald, Sharlene A Greenwood","doi":"10.1159/000549971","DOIUrl":"10.1159/000549971","url":null,"abstract":"<p><strong>Introduction: </strong>The GFR-Ex study assessed the feasibility of a 12-month exercise training program to attenuate the rate of decline in isotope-measured (mGFR) and estimated (eGFR) glomerular filtration rate.</p><p><strong>Methods: </strong>In a multicenter feasibility study, people with stage 3-4 chronic kidney disease (CKD) with declining function were randomized to 12 months exercise training (home-based aerobic and resistance program) or control (usual care). Feasibility was assessed by recruitment and retention rates, intervention adherence, and harms. Differences in mGFR between groups at 12 months and between mGFR and eGFR were calculated. Qualitative interviews were used to explore participant experiences.</p><p><strong>Results: </strong>A total of 2,260 patients were screened; 74 participants were randomized (mean age [SD]: 56 [14] years; eGFR: 34 [13] mL/min/1.73 m2; 62% male; 61% white); and 34 completed the study (11 exercise; 23 control). The screening eligibility rate was 11%; consent rate was 48%; 12-month retention rate was 43%; and the median (IQR) exercise sessions completed was 69 (63, 72)%. No exercise-related harms were recorded. The mean mGFR at 12 months was 36.1 (exercise) vs. 33.8 (control); eGFR minus mGFR was -1.6 (95% Cl: -2.6, -0.6) mL/min/1.73 m2. Qualitative interviews identified the importance of peer and professional support for patient engagement and a high level of patient commitment being required for the research procedures.</p><p><strong>Conclusion: </strong>In people with progressive CKD, a 12-month exercise training program was safe and feasible. Exercise tended to attenuate GFR decline, and eGFR agreed well with mGFR. Progression to a definitive trial is warranted, provided modifications are made, including providing patient support and selection of eGFR as the primary outcome.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":3.2,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' Response to \"Urinary and Plasma KIM-1 in Chronic Kidney Disease: Prognostic Insights and Remaining Questions\".","authors":"Thomas McDonnell, Magnus Söderberg, Maarten W Taal, Nicolas Vuilleumier, Philip A Kalra","doi":"10.1159/000550127","DOIUrl":"10.1159/000550127","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-2"},"PeriodicalIF":3.2,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Analysis of Left Ventricular Myocardial Work in Patients with Diabetic and Non-Diabetic Kidney Disease after Peritoneal Dialysis.","authors":"Minjie Wan, Chunyan Yi, Yan Wang, Yagui Qiu, Jianwen Yu, Jianxiong Lin, Wei Chen, Haiping Mao, Xiao Yang, Fengjuan Yao, Donghong Liu, Qunying Guo, Yanqiu Liu","doi":"10.1159/000550324","DOIUrl":"10.1159/000550324","url":null,"abstract":"<p><strong>Introduction: </strong>Initiation of dialysis encompasses new cardiovascular challenges for patients with end-stage kidney disease (ESKD). The prognostic value of assessment of left ventricular (LV) myocardial function in peritoneal dialysis (PD) patients is still unclear. This study used global LV myocardial work (MW) indices to investigate the change of LV myocardial function undergoing PD within 1 year.</p><p><strong>Methods: </strong>A total of 179 patients with ESKD were enrolled in this prospective study. Among them, 48 patients were diagnosed with diabetic kidney disease (DKD), and 131 patients had non-diabetic kidney disease (NDKD). We evaluated LV myocardial function of patients with ESKD by two-dimensional speckle-tracking echocardiography (2D-STE) with strains and MW indices. Echocardiography and clinical data were evaluated at baseline and 1 year after PD.</p><p><strong>Results: </strong>Compared with the NDKD group, patients with DKD had lower global longitudinal strain (GLS) (14.43 ± 3.52 vs. 16.78 ± 4.78; p = 0.002), global work index (GWI) (1,546.29 ± 496.06 vs. 1,750.51 ± 416.97; p = 0.006), and global constructive work (GCW) (1,955.33 ± 483.86 vs. 2,129.65 ± 459.04; p = 0.028). After PD therapy, the NDKD group showed a significant reduction of GWI (1,616.78 ± 360.18 vs. 1,750.51 ± 416.97; p < 0.001), GCW (1,980.45 ± 385.82 vs. 2,129.65 ± 459.04; p = 0.006), and global wasted work (GWW) (158.00 [102.00, 219.00] vs. 185.00 [141.00, 250.00]; p < 0.001) and an increase of global work efficiency (GWE) (92.00 [89.00, 94.00] vs. 91.00 [88.00, 93.00]; p = 0.008). Compared with the NDKD group, the DKD group had a less decrease of GWW (-14.00 [-69.75, 85.00] vs. -36.00 [-97.00, 21.00]; p = 0.020) and a less increase of GWE (-1.00 [-4.00, 2.00] vs. 1.00 [-2.00, 4.00]; p = 0.006) after PD therapy. After multivariable adjustment, Δresidual GFR (β = -0.165; p = 0.034) and ΔDBP (β = -0.168; p = 0.028) were the significant independent determinants of ΔGWE. ΔDBP was the only significant independent determinant of ΔGWW (β = 0.343; p < 0.001).</p><p><strong>Conclusion: </strong>After 1 year of PD treatment, patients with NDKD showed improved LV myocardial function. However, the benefit for DKD patients was relatively limited, reflected in a smaller increase in GWE and a smaller reduction in GWW.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":3.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Finerenone in Patients with Idiopathic Membranous Nephropathy: A Multicentre, Prospective-Retrospective Real-World Study.","authors":"Jia-Yi Li, Yu-Lin Zhu, Jian-Peng Zhang, Jia-Mei Lu, Xiao-Yong Yu, Jing E, Yang Wei, Dan-Na Ma, Akhmedova Nilufar Sharipovna, Jason Choo, Chieh Suai Tan, Min Qi, Yan Li, Xiao-Tao Ma, Zhe Kang, Zhao Chen, Xiang-Hui Chen, Rong-Guo Fu","doi":"10.1159/000550311","DOIUrl":"10.1159/000550311","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy and safety of finerenone in patients with idiopathic membranous nephropathy (IMN) remain unclear, especially given the need for additional supportive therapeutic options.</p><p><strong>Methods: </strong>This prospective-retrospective, multicentre, observational real-world study evaluated the efficacy and safety of finerenone in IMN patients with proteinuria ≥1 g/24 h. The primary outcome was the percentage change in proteinuria from baseline to 6 months with finerenone treatment. Secondary outcomes included the stratified reduction in proteinuria, and changes in estimated glomerular filtration rate (eGFR), serum albumin (ALB), and total cholesterol (TCHO). Safety assessment focused on serum potassium. Data were primarily analysed using linear mixed-effects models.</p><p><strong>Results: </strong>Among 112 IMN patients treated with finerenone, 79 were ultimately analysed. All of them received tolerated doses of ACEIs or ARBs, and 53.2% (42/79) were treated with immunosuppressive therapy. The median baseline proteinuria was 3,212.5 mg/24 h (IQR 1,977.0-7,113.6). After 6 months of finerenone treatment, the geometric mean reduction in proteinuria was -58.5% (95% CI: -67.7 to -46.6; p < 0.001). The reduction was significantly greater in patients receiving immunosuppressive therapy than supportive treatment (-67.1% vs. -45.3%, p = 0.023). eGFR showed an initial decline but subsequently stabilized (-1.3 mL/min/1.73 m2, p = 0.226). Significant improvements were observed in ALB (4.6 g/L, p < 0.001) and TCHO (-0.8 mmol/L, p = 0.003). Although hyperkalaemia (>5 mmol/L) occurring in 5.1% of participants (4/79), no cases exceeded 5.5 mmol/L.</p><p><strong>Conclusion: </strong>In combination with ACEIs or ARBs, finerenone appeared to reduce proteinuria in IMN patients with or without immunosuppressive therapy. Serum potassium did not exceed 5.5 mmol/L in any cases.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-11"},"PeriodicalIF":3.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}